Healthcare Provider Details

I. General information

NPI: 1366235020
Provider Name (Legal Business Name): ISAAC JAMES UNGERSMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11375 BIG BEND RD
RIVERVIEW FL
33579-7183
US

IV. Provider business mailing address

21756 STATE ROAD 54 STE 102
LUTZ FL
33549-2905
US

V. Phone/Fax

Practice location:
  • Phone: 813-805-8167
  • Fax:
Mailing address:
  • Phone: 813-279-6234
  • Fax: 888-492-7854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTT43173
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: